Sleep and Death

 My dad is in the terminal stages of brain cancer, and as the disease has progressively attacked his mind, he has inevitably gotten more confused and disoriented over time. 

Having cruelly robbed him piece by piece of his eyesight, his mobility, his work, and his short-term memory, the cancer is taking dad closer each day to what Hugh MacDiarmid called the "dread level of nothing but life itself." 

"We're down to just the basics here," as my mom put it yesterday—sleeping, eating, breathing, having a BM. 

But I always said that even in the final stages, dad's ministry and his spiritual values would be the last things to go; and that appears to be true. Last night, as my sister and I sat up with him during a brief period of wakefulness, he mostly kept up a monologue about the power of transformative love. 

"I want to leave everyone with a warm heart full of love," he kept saying. 

But he also—for the first time—seemed to talk about death as something imminent. "I have an odd question," he said at one point, with the distinctive locutions he uses in his present mental state; "When exactly will I click off from this planet?"

We don't know, my sister and I told him. "It depends how long your body fights off the cancer." 

"How about an estimate?" my dad asked—an eminently reasonable question.

"Maybe weeks," I said. "Maybe days," my sister added. "Or months."

Dad seemed to feel last night, though, that the end was coming much sooner than that. 

By a certain point in the conversation, he started to look very tired and was having more difficulty finishing his sentences. We asked him whether he would like to lie down and rest. 

"It's probably time to sleep," he agreed; "and maybe a little bit more than that!"

This prompted some uneasy laughter. "Not on my watch!" said the caregiver. 

We asked him again, a few minutes later, if he wanted to lie down and rest. 

"I would do so," he said slowly, "if I could be sure that I would wake up in the morning with a warm heart." 

This way of phrasing it was somehow extra anguishing. As was what came next. 

Dad turned his gaze up to the ceiling momentarily and said: "Do you all feel that or is it just me? That gust of cold air?"

Into my heart an air that kills... the line from Housman popped into my brain. Despite dad's unusual way of phrasing things in his advanced cancer state, after all, it was impossible to mistake what he was talking about. 

On a literal level, he was saying he was cold—he's complained about the air conditioning ever since he was discharged from the hospital, even when the rest of us are sweltering in the late Florida spring. 

But his image of the "warm heart" also had plainly come to represent something about his ministry and the legacy he wanted to leave behind. The warm heart meant his life—and he was afraid that if he closed his eyes that night, he would not open them again on a world where it was still beating. 

Dad is after all on hospice care. He's not wrong that there are now a lot of health care professionals hovering around who proceed on the assumption that he will indeed "click off this planet" any day now. 

Hospice itself only becomes available when someone has a life expectancy of six months or fewer. And dad is showing most of the signs of the end stages of his glioblastoma diagnosis. He is sleeping most of the day and night—only getting out of bed for brief meals and the occasional shower—though even this he has started to resist. 

The hospice people dutifully delivered their "comfort kit" to our freezer—a euphemism for a morphine supply and its injector. But so far dad has not needed to use it. Glioblastoma, while it has few enough blessings, lord knows, at least tends not to involve a lot of pain—unlike other forms of cancer. 

Dad's twenty hours a day or more of sleep, then, are coming without the aid of any narcotics. It's just what his body is saying it needs right now. It's a sign that he is naturally and gradually shutting down. 

In his poem "Morphine," about his own bed of sickness, Heinrich Heine wrote that there were two brothers ever by his side: sleep and death. For a time, he wrote, morphine-induced sleep was sufficient to comfort him. But as its effects wore off, he came to feel the need increasingly of the second brother. 

My dad is plainly spending his nights now with the same two brothers at his bedside. And he has reached a stage when he can no longer turn to one without having to consider that the other may be about to take his place. "I would sleep if I could be sure I would wake up with a warm heart..."

He longs to invite in sleep. But not one of us knows for certain, at this stage, when one brother might tap the shoulder of the other in the night and substitute for him at my dad's bedside.